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WORK PLANS_CASE 1
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545336
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WORK PLANS_CASE 1
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Entry Properties
Last modified
2/10/2020 5:18:19 PM
Creation date
2/10/2020 4:06:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
FileName_PostFix
CASE 1
RECORD_ID
PR0545336
PE
3528
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
02
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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F .w <br /> � ab <br /> Amp, WORK ORDER M 03 - C7D❑ <br /> Cooler Of <br /> SAMPLE RECEIPT FORAM <br /> CLIENT: DATE: /D� <br /> F <br /> ATURE—SAMPLES RECEIVED BY: <br /> NCE COURIER: LABORATORY(Other than Calecierwe Courier): <br /> hilled. Cooler with temperabire blank provided. °C Temperature blank. <br /> Chilled,cooler without temperature blank °C IR thermometer. <br /> Chilled and pled In cooler with wet toe. Ambient temperature. <br /> Ambient and placed in 000ler with wet fee. <br /> Ambient tempersturs. <br /> °C Temperature blank. Inift„� 1 <br /> CUSTODY SEAT.INTACT: <br /> Sample(e): CoolerNo(Not Intact): Not Applicable(NIA): <br /> Initial: <br /> SAMPLE CONDITION: <br /> Yea No WA <br /> Chain-WCBody document(s)rocehred with samples......................... ��,..,.. .... <br /> Sample container label(s)consistent with custody papers..................... .,... ....... <br /> Sample container(s)intact and good condition.................................. .... ....... <br /> Correct containers for analyses requested........... ............................. _�. . .... .... <br /> Proper preservation nobed on sample label(s)..................................... .... r <br /> VOAvial(e)free of headspace. ............... ....... ............................. .. .... <br /> Tedlar bugle)free of condensation................................................... ....... ... ,... �� <br /> Initial: <br /> COMMENTS: <br />
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